The Elbow - Sports Surgery Clinic, Dublin

Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries

The Elbow



INTRODUCTION

THE ELBOW

The elbow is the link between the arm and the hand and wrist. It allows you to place your hand in many positions, allowing you to brush your hair, scratch your back, feed and wash yourself. The elbow plays a fundamental role in all actions involving the upper limb including reaching, lifting, carrying and throwing motions.

Elbow pain can result from a number of factors including fractures (bone injury), ligament and tendon problems (soft tissue injury), and degeneration due to previous injury, manual work, inflammatory conditions and/or aging.

HOW THE ELBOW WORKS

The elbow is a complex hinge joint formed from the end of the humerus in the upper arm and the top of the ulna and radius in the forearm. The elbow allows flexion and extension of the forearm relative to the upper arm, and rotation of the forearm and wrist.

The arch of bone at the end of the humerus is made up of the medial epicondyle on the inside and the lateral epicondyle on the outside of the elbow. The tendons of the forearm muscles attach to these epicondyles. Inside the bony arch is the capitellum which articulates with the top of the radius and the trochlea around which the olecranon of the ulna bone moves. A layer of smooth articular cartilage covers the ends of the

Anatomy of the Elbow

Biceps muscle Biceps tendon Radius

Ulna

Humerus

Annular ligament of radius

Anterior band

The Elbow joint

Humerus

Radius

Joint cavity

Joint capsule

Ulna

Articular cartilage

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THE ELBOW

INTRODUCTION

bones forming the elbow joint. The joint capsule has a thin lining of synovium to provide lubrication to the elbow allowing smooth motion.

The bony configuration of the elbow gives it stability that is assisted by an extensive network of ligaments and tendons. The medial (inside) and lateral (outside) collateral ligaments attach and maintain the position of the radius and ulna relative to the epicondyles of the humerus. These ligaments allow various movements of the elbow while resisting dislocation of the joint.

At the front of the elbow, the end of the biceps tendon passes over the joint and attaches to the radius allowing supination (rotation) and flexion of the forearm relative to the humerus. At the back of the elbow the triceps crosses the joint and controls extension. The olecranon bursa is at the posterior tip and is a sac-like membrane which cushions the tip of the elbow and helps smooth movement of the joint.



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APRSOSEBSLSEMESNATND TREATMENTS

TENNIS ELBOW & GOLFER'S ELBOW

"Tennis elbow" or Lateral Epicondylitis causes pain over the outside of the elbow. It is not only caused by racquet sports but can occur with any activity where repeated twisting and extension of the wrist is required. The condition can be caused by degeneration or tears of the tendons attaching to the lateral (outside) epicondyle. Similarly, "Golfer's elbow" or Medial Epicondylitis is

caused by problems with the tendons attaching to the medial (inside) epicondyle. Treatment often involves a combination of physiotherapy, bracing and steroid and/or Platelet-rich Plasma (PrP) injections. Surgery may sometimes be required. Prevention programmes focused on warm-up stretches, and equipment changes such as racquet grip sizing are important.

Tennis Elbow Right arm lateral (outside) side

Humerus Extensor muscles

Lateral epicondyle

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THE ELBOW

Injured common extensor tendon

APRSOSEBSLSEMESNATND TREATMENTS

OLECRANON BURSITIS

Olecranon Bursitis or "Popeye Elbow" causes swelling and redness of the posterior tip of the elbow. Bursitis can be caused acutely by falling on the tip of the elbow or by repetitive leaning the tip of the elbow on a hard surface. It has been associated with repetitive motion in golf and racquet sports, and inflammatory conditions such as gout and rheumatoid arthritis. Many patients may have a bone spur or "enthesophyte" at the tip causing further irritation of the sac-like bursa. As the bursa becomes inflamed it secretes extra fluid within its closed cavity. Rest, antiinflammatory medications and antibiotics (if infected) are required. Patients who develop recurrent problems need surgery to have the bursa and the bone spur removed.

Healthy elbow

Unhealthy elbow

Humerus

Humerus

Radius Ulna

Bursa

(normal size)

Radius Ulna

Bursitis

(enlarged)

ULNAR NERVE PROBLEMS

Cubital Tunnel Syndrome is caused by entrapment of the ulnar nerve on the inside of the elbow. Patients may describe "pins and needles" from the inside of their elbow travelling down to the ring and little fingers. As the compression on the nerve gets worse or is prolonged, the patient may notice wasting of the inside of the forearm or the back of the hand. After appropriate investigations, your surgeon may advise surgical release of the nerve behind the elbow.

Ulnar Nerve Impingement

Humerus Radius

Ulnar nerve

Ulna



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